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U.S. Cancer Death Rates Decline Overall, but Some Cancers Are on the Rise

The decline in smoking, better use of screening, and early detection have caused some cancer death rates to plummet, but rates of some cancers — such as liver and uterine cancer — are climbing. The obesity epidemic and the opioid crisis could be responsible.

The annual report on statistics and trends shows a steady 1.5 percent drop per year in cancer deaths since 1991. That translates to about 2.6 million fewer cancer deaths in the United States over that time period. However, cancer still accounts for 22 percent of all deaths in the country, making it the second-leading cause of death after heart disease. Cancer is the leading cause of death in Hispanics and Asian-Americans under age 80.

Fewer Smokers, Screening, and Early Detection Drive the Trend

The decline in smoking is the biggest reason why cancer death rates have fallen and why lung cancer incidence rates have also declined, says Rebecca Siegel, ACS scientific director of surveillance research. The death rate for lung cancer dropped 48 percent from 1990 to 2016 among men and 23 percent from 2002 to 2016 among women. It continues to decline.

“Prior to 1991, death rates for cancer were increasing rapidly. That was driven by lung cancer rates in men because of the smoking epidemic,” Siegel says. “This consistent decline we’ve seen for the past 25 years is largely the result of declines in smoking but also because of improvements in treatment and early detection of some types of cancer.”

Better treatment and screening, such as mammography and colonoscopy, appear to have had a significant impact on death rates for some types of cancer. Small tumors confined to the breast that are found by mammography are highly curable, while colonoscopy may identify precancerous lesions, called polyps, that can be removed before they become cancerous.

The rate of deaths from breast cancer fell 40 percent between 1989 and 2016. Colorectal cancer death rates dropped by a stunning 53 percent from 1970 to 2016. And although prostate-specific antigen (PSA) testing is controversial because the test may find slow-growing cancers that do not need to be treated, screening and better treatment has led to a 51 percent drop in prostate cancer deaths from 1993 to 2016.

Lung cancer incidence and death rates could fall even further if more people, such as current or past heavy smokers, took advantage of low-dose computerized tomography (CT) screening to detect the disease in its earliest stages, before symptoms appear, Siegel says. But low-dose CT screening is not available everywhere and people may not know if they are appropriate candidates for screening. “Right now not many people are being screened,” she says.

Immunotherapies will likely continue to cure some patients, said James P. Allison, PhD, a Nobel laureate and fellow of the American Association for Cancer Research Academy who was an immunotherapy pioneer, in a blog published January 4, 2019, by the American Association for Cancer Research.

“I think the success in recent years with immunotherapy is giving a lot of people, including researchers and patients, some optimism that at least some types of cancer can be cured in some people,” Dr. Allison said. “I am very hopeful that we can make immunotherapies work even better.”

But, according to Siegel, it’s likely too soon to see the impact of these successes in the statistics. “It takes quite a bit of time to see that,” Siegel says.

Not All of The News Is Good, and Obesity Is a Problem

Cancer incidence rates have risen for melanoma and cancers of the liver, thyroid, uterus, and pancreas. Moreover, death rates are rising for some types of cancer. From 2012 to 2016, death rates rose for:

Liver cancer in men, by 1.2 percent per year

Liver cancer in women, by 2.6 percent per year

Pancreatic cancer in men, by 0.3 percent per year

Uterine (or endometrial) cancer in women, by 2.1 percent year

Cancer incidence has also increased recently for cancers of the brain and within the oral cavity and pharynx. Oropharyngeal cancers are linked to human papillomavirus (HPV) infection, according to Siegel. Some other types of cancers that are increasing, such as liver cancer, may be linked to obesity.

“The most alarming statistic is the trend for liver cancer,” Siegel says. “Liver cancer is the fastest-increasing cancer right now in the United States. It’s concerning because about 70 percent of liver cancer cases are potentially preventable. There are a lot of factors that cause the disease that are modifiable: obesity, alcohol consumption, smoking, and preventing hepatitis B and C virus infection.”

For example, she says, hepatitis C infection rates are increasing due to the rising rates of opioid addiction in the United States. While there are treatments for hepatitis C infection, it can be too expensive for some patients, she says.

Researchers are also concerned about the rising rates of endometrial cancer, Siegel says.

“Rates of endometrial cancer in women have been increasing for quite a few years now,” she says. “That is thought to be related to the obesity epidemic. But it’s not certain. The tricky thing with endometrial cancer is the rates reported don’t reflect hysterectomy trends. There are fewer hysterectomies now than in the past — and that changes the risk pool.”

While colorectal cancer incidence is declining due to better screening adherence, the disease is becoming more common in people under the age of 50. That trend may also be linked to obesity, she says.

The obesity epidemic will present a challenge to further reducing cancer rates, she says.

“Obesity is very complex,” Siegel says. “It’s about access to affordable, healthy food and increasing the availability of places where people can be physically active in a safe environment. There are a lot of challenges there. But we can use some of what we’ve learned in the tobacco epidemic to apply to obesity. We’re only probably starting to see the tip of the iceberg in terms of the influence on cancer trends. It takes many years to see the influence of obesity on the rates.”

Poor People Are More Likely to Die From Cancer

Several recent studies suggest that the difference in survival rates between racial groups is shrinking. But disparities still exist that are largely linked to socioeconomic status. One study published October 23, 2018, in the journal Cancer Epidemiology, Biomarkers & Prevention, for example, showed differences in breast cancer outcomes were tied to whether patients, no matter their ethnicity, were treated in poorer counties compared with wealthier counties across the country.

The ACS report shows that the rate of cervical cancer deaths among women in poor counties in the United States is twice that of women in affluent counties, while lung and liver cancer mortality is more than 40 percent higher in men living in poor counties compared with those in affluent ones. Colorectal cancer death rates are 35 percent higher for men living in poorer counties compared with men in more affluent counties. People living in poorer counties may have less access to cancer screening services and may undergo care at under-resourced healthcare facilities, Siegel says.

“For cervical cancer, which is almost 100 percent preventable, death rates are two times higher in women living in poor counties than women living in affluent counties,” Siegel says. “It’s heartbreaking because it doesn’t have to be that way.”

For cancers that are challenging to treat no matter where one lives — such as some leukemias, non-Hodgkin lymphoma, and pancreatic and ovarian cancers — there is little difference in death rates by socioeconomic status, Siegel says. States that have addressed socioeconomic disparities have seen reductions in cancer disparities, she notes.

“When you increase access to care, you weaken the link between socioeconomic status and health,” she says. “States like Massachusetts and Delaware have shown it. They have eliminated barriers to care [such as through expanded access to Medicaid] and reduced or eliminated racial and socioeconomic disparities in cancer mortality. Once you provide equal care, the disparities go away.”